Healthcare Provider Details

I. General information

NPI: 1639014665
Provider Name (Legal Business Name): SELAH ACUPUNCTURE P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14785 JEFFREY RD STE 109
IRVINE CA
92618-0410
US

IV. Provider business mailing address

14785 JEFFREY RD STE 109
IRVINE CA
92618-0410
US

V. Phone/Fax

Practice location:
  • Phone: 714-461-9160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name: JIWONG KIM
Title or Position: CEO
Credential: L.AC.
Phone: 714-461-9160